Thursday, December 10, 2009

Pharmacist Immunizations. Is There Something I'm Missing Here?

So, let me get this straight.

The giant corpro-pharmacy chains would like us to take some free time out of our schedule to learn how to give people immunizations.

Hm, OK, the thought of jabbing something sharp into my customers does have a certain appeal.

And afterwards, they would like us to somehow magically make time in our workday, because there is so much free time in the average retail pharmacists workday mind you, to stop the prescription filling process and jab random numbnuts who give them $30 and decide it's time for a flu shot?

And they expect us to do this, for free? At least that's how it's proposed to work at the corpro-pharmacy that butters my bread. Not one extra dollar in my paycheck. The only incentive provided being I am graciously allowed  to take vacation time to attend the training classes.

Do they think I'm stupid, and have failed to notice the part where they get 30 extra dollars out of the deal, or do they think I'm just insane? Why on earth would I go out of my way to make myself more valuable to them for nothing in return? When I ask them, what I hear are the usual bullshit platitudes about how pharmacists, being the most accessible health care professional, are in a unique position to benefit society by setting up a front line of defense against the annual flu pandemic......blah blah blah......

Which is right of course, but, listening to that answer, I can't help but to think how corporation's willingness to help society seems inexorably linked to how much money is in it for them.

Which is why I will be more than happy to become an immunization-certified pharmacist. And volunteer my services to a public health clinic. The fact you would expect me to donate additional skills and training to you for free, corpro-pharmacy, is an insult to the profession.

Of course, there is nothing new about corpo-pharmacy insulting the profession.

And there is nothing new about the insulted professionals taking it like a pillow chomping bottom.

If you've done this, if you're sticking it to people while getting it stuck to you by the man, for the love of God please explain to me why.

45 comments:

Allison said...

Several years ago we were forced, as part of our coursework in the Great State of Ohio, to become both CPR and immunization certified. I've since moved to Michigan, and to hospital pharmacy. I let the nurses stick people and handle diaper duty..I'm good on this side of the window.

Anonymous said...

You wanted to know why pharmacist are taking on this extra responsibility thrust upon us by our employers. While it is great to think that each of us can stand up to the people who sign our checks, you have to be sympathetic to the fact that these corporations can control where and when we practice our professions. In other words, do you wish to be work close to your home. Do you want to continue to have a full time position? There are rumors that some of the chains have threatened to change some pharmacists to floaters if they refuse to train as immunizers. The tougher issue is expecting the pharmacist to work these immunizations into the already busy day.

Anonymous said...

I plan on leaving my current job at WAG for exactly that reason...it is unsafe to add another task to my already jam packed day! RIDICULOUS!!!

Anonymous said...

As another WAG pharmacist, the options were give immunizations are expect to work nights for the indefinite future (and also be shifted from store to store to store).
So after getting certified and giving immunizations on top of the regular increased end of year business we are rewarded with decreased support staff hours.
(They obviously don't need 40 hours paid a week to support themselves), but it is sure nice of them to pick up out-of-stock items from other stores on their way in, on their own time and their own dime for the transportation.

Anonymous said...

At my chain they "strongly encouraged" pharmacists to become immunizers. And if any pharmacist refused they got put into the float pool and lost their store. Don't like the idea of giving shots? Hate needles? Go into pharmacy specifically to not work with needles and have this added liability? To bad. If you want to keep your store, you'll do it.

Anonymous said...

Without the negative reinforcement this kind of scam plays into some pharmacist's worst fears. I could just imagine the conniptions I'd have to face with the thought of administering injections at a moment's notice on any given day, or be laid off.

I know what phobias are and severe anxiety attacks, but much as I admire cross-training and flexibility afforded by advanced skills, there are some limits.

It would take years of desensitization for me to overcome handling my aaichmophobia very close to bare human injection sites. Don't get me wrong, I have no problem shooting up a morphine drip or compounding a PPN, but the thought about some needle or blunt catheter being shoved through epidermis into a patent vein just make me shiver.

Anonymous said...

I too could not believe that we, as pharmacists got no extra money for administering these shots. Because I was told that the first shot paid for the whole vial and I know I can get about 11-12 shots per vial, which means they are making about $250 per vial because in WI our shots cost $25. Had some of the worst days of my young career this year when I was the only pharmacist on duty and we were really busy and I had to give 15-30 shots on top of you know, answering patient calls, taking voicemails, checking waiters, checking non waiters, consulting the front, answering doctor's phone ins, consulting drive. When they sent me up north I was extra and gave about 60-70 shots per day. It isn't all that bad, except when the people shink really bad or have almost no muscle to inject. But I couldn't help but wish I got a dollar or two for every one I did. The company's stock sure did go up a lot since we started doing this I noticed. I have heard that people who refused to get the training have now been switched to night shifts and sometimes have to work at other stores.

Anonymous said...

Another WAG pharmacist here who gave in and got certified so as to keep my staff job instead of being floated to stores as far as 2 hours away. I couldn't up and quit or make enough ruckus to get fired since I'm still under the devil of a sign-on contract. It expires next summer and I'll be damned if I was gonna pay WAG $30K + 8% interest per year to leave. I'm just glad I won't have to be around for next year's flu season.

The PharmD Student said...

And you have to take into account the young guns like me who are being trained in school to do immunizations.

Many of my classmates don't know the shittiness that is retail pharmacy, and would gladly accept a job in Cali.

Think you can't be replaced? Ha! I bet someone graduating this spring would take your job for less pay.

Because they're retarded.

The Alert Reader said...

the pharmd student is so hot. lol

Jan said...

Just wait until they decide that your new job responsibility is to start an IV or replace a cracked filling.

I mean, you can do those things, right? By the way, change my oil, will you?

Anonymous said...

It is quite un-nerving to hear the tales of "bullying" by WAG and some other chains. I am not certified to give immunizations and I have no plans to become certified. I am not a diabetes educator nor am I certified to do MTM. I receive no extra compensation for any of those titles so why would I put forth extra effort to generate MORE money for my company while receiving NOTHING in reurn except an increased workload. Thankfully, my company has yet to resort to these strong arm tactics, although I fear if "the pharmacy america trusts" can get away with it the others won't be far behind. The most unfortunate part of this is that we have absolutely no voice within the industry. We are the back-bone propping up a multi-billion dollar per year business yet we have no autonomy. Our profession has sold us out. The pussies and the yes-men that sit on state boards across the country have destroyed any integrity pharmacy once had by letting our profession be turned into a $4/coupon fueled joke.

evilchainrph said...

Ah, but you WILL get paid...in your bonuses! Never mind that because of you, the other staff pharmacist who is not trained to give shots and didn't inject a million people this season will get the same bonus as you, the person who did ALL the work.
At WAG (at least in my district) they are making ALL pharmacists be immunizers, including 3rd shift pharmacists. Ok, who would walk in to the pharmacy at 2am, asking for a flu shot? Not me, I'd rather be sleeping.

Anonymous said...

Time to strike people! oer start a union... or a pharmacy protection group??? How come doctors have the AMA and what do we have???

Anonymous said...

I went into pharmacy 10 years ago so I wouldnt have to touch people or work with needles. In September, WAG forced all non-immunizing RPh's to work all 2-10 shifts as floaters. I have worked for them for 8+ years and have been a pharmacy manager for over 5 of those years. My store completely fell apart while my partner and I were forced to work at other stores/and or close/clean up after these immunizing pharmacists wrecked the place working all of our 8-4's. It was COMPLETELY rediculous - I have a family that needs me that I didnt see for an entire month. Im so glad that the WAG gives a shit about its employees and the needs of their families!! (on a side note, I am now an "immunizing pharmacist" so I dont get screwed next year!)

Anonymous said...

Good Lord! I wouldn't want a flu shot administered to me by my pharmacist any more than I would my auto mechanic! I know it's not rocket science, but if someone is going to jab a needle in me, they better have lots and lots of practice. It's not what pharmacists do or are trained for. What on earth are these corpos thinking? Why don't they just train the cashiers to give shots, since they feel the person doing it needs no actual background in direct patient care?

rpn0111 said...

I feel before we "expand our professional role", we need to be doing better at our present responsibilities. Honestly, most of us are already lacking on adequate patient counseling and meaningful drug usage review. I have been informed the corporate goal is 100% immunizing RPh, to promote vaccinations at "any store, any time".
Working solo 7 or 8 hours overnights, I already have dozens of things that bring my "demand indicators" to zero for a 15 minute block. Sooner (rather than later) somebody WILL come in at 2am for a flu shot, 5 minutes before a mom with 2 sick kids pulls into the drive-thru from the ER, or other "hell breaks loose".
We are no longer "The Pharmacy America Trusts". Now, "There's a Way" (to alienate/demoralize previously content pharmacists).

The Alert Reader said...

Anonymous (10:48AM), you are an idiot.

Pharmacists, especially those in retail, have an extensive background in 'direct patient care'. Just because they rarely get to exercise that skill in practice because of corporate demands does NOT detract from their abilities.

Pharmacists are just as qualified to administer vaccines as nurses and doctors. As a pharmacy student who learned the technique in under an hour, it is NOT that hard. Seriously. (And yes, we did use real syringes/needles on real deltoid muscles. NOT THAT HARD.) "It's not what pharmacists do or are trained for"? Did everyone else who commented on this post NOT just mention the fact that they got certified as immunizing pharmacists? Do you not understand that certification requires training? Yes, training -- in both the storage and handling of the vaccine, the administration of the vaccine, as well as basic life support/CPR in the case of anaphylaxis.

"if someone is going to jab a needle in me, they better have lots and lots of practice." They do have practice. The last step in certification is to give an actual shot. To yourself. I don't think it gets more intense than that.

Vaccines are drugs. Pharmacists are drug specialists. To insinuate that they lack experience in direct patient care, are unqualified to administer an IM injection, and compare them to mechanics and cashiers, is insulting to say the least. You are an idiot. And you missed the point of this post ENTIRELY. (Hint: Pharmacists are awesome at what they do and should be rewarded for their efforts instead of forced to squeeze in another money-maker for their retail chain that ultimately sacrifices the safety/accuracy of the prescriptions they fill on a regular basis.)

Anonymous said...

I had to become certified in school but don't ever plan on doing it - just not my thing. CVS may be a giant corporate monster but they don't make me immunize & have never even asked me if I'm certified. Flu shot? Let me direct you to the NP in the minute clinic.

joannaquast said...

I'm so happy I work in a hospital... every time I read this!

Heather said...

As a consumer, I have been puzzled about this practice all year. Considering there are flu clinics all over the place around here- why someone would want to get a shot at a Target or a Safeway is beyond me.

I administered my own allergy shots starting in high school. Drawing a shot, preparing a site and pushing the plunger isn't exactly rocket science- but it's not why I go to the pharmacy.

Let's make a list of all the other places we should make the lines longer by offering flu shots.

The DMV
The post office
The bank

Anything else?

misbehavis said...

@ rpn0111 WAG's new slogan... "Walgreens, it's WAG's way or the highway"

Anonymous said...

I'd bet a weeks pay that Fred Eckle thinks we should be immunizing.

Anonymous said...

WAG manager here (you know, all the responsibility, no authority). I was one of the first RPh to be certified way back in '99; I refused to do it for WAG because there was no increased compensation for the increased risk. My staffer (new hire, foreign grad, incompetent--I didn't hire her sorry ass) gave the flu shots and I got to work nights. Pharmacy went down the toilet, but we gave shots. Miracle nobody got infected, but what the hell better to be lucky than smart. Can't wait to see Kermit's next "Ready--Fire--Aim" project. It'll be a clusterfuck, ah gah-ron-tee.

Ray Liotta said...

As I was fond of saying in "Good Fellas",

"Fuck you, pay me."

Anonymous said...

I understand the extra demand that immunizations puts on pharmacists. Overall, The problem seems to be the corporate handling of immunizations rather than immunizations and that is important to recognize.
Many pharmacists are merely "glorified clerks" and giving immunizations offers the opportunity to step out of that role and offer an important value added service.

Anonymous said...

Wait til you have a costumer go into full blown anaphylaxisafter the injection.

I never had a flu shot til age 30, and decided to get one at the health department.

I got the shot and when to shock about 2 mins later. Yeah, I'm sure that made everyones day.

At least you got Epis there...

LD50 Rat

AnotherPharmTech said...

A memo came down from WAG district office in my area a few days ago...get immunization-certified, or you probably won't get scheduled at all during the upcoming flu season. Apparently having flu shots available EVERY SINGLE DAY FROM 10 to 6 DURING ALL OF SEPTEMBER this past year wasn't enough...they are planning to promote an immunizing pharmacist in EVERY STORE, ALL THE TIME during the next flu season. Are you kidding me? And, apparently, if my pharmacists don't want that particular joy, they more or less lose their jobs.

Oh, did I mention that 1,500 doses of H1N1 vaccine arrived in my store yesterday, and we are expected to sell them ALL with no extra staff?

After POWER and this flu shot shit, I am seriously considering using my pharmacy undergrad to become a dentist or chiropractor or something instead. This is ridiculous.

Anonymous said...

No one should be "selling" the H1N1 vaccine since the generous portion of our salary that goes to Uncle Sam already took care of that expense.

Stavros69 said...

Dot Matrix! In high tech terms that is ancient.

Anonymous said...

We are not selling H1N1. We are charging a fee for administering it. A fee that is 100% profit to the pharmacy and 0% for the over worked stressed out pharmacist forced to give it.

What a joke retail pharmacy has turned out to be! Run while you can kids!

Anonymous said...

Only reason pharmacy chains are promoting pharmacist immunizers is because they have cutthroated all the profit out of filling scripts. So now they can make money on immunizing. BUT how soon will it be before chain down the street starts doing shots for $19.99 instead of $30. Then chain across the street says well we will do them for $9.99...and so on. Then what will they ask us RPh's to do next?!?!? -Daryl_RPh_in_OH

Anonymous said...

In addition to WAG pharmacists, let us not forget Kroger-they are forcing all pharmacists to go thru immunization training, CPR training, and suggestioning we get Hep B shots...and if you do not, they are not only putting us in float pools, but SUSPENDING people for refusing to give shots! We have a union, but they are not doing one thing about this. So much for our union dues working for us. One pharmacist was suspended twice, even with a Dr. note saying her rheumatoid arthritis prevented her from giving shots--she got personal instruction AGAIN, and was put in the float pool.

All of these comments totally express my opinion as well..we are the cash cows for corporations...never in my 40 yrs of practice have I seen such crap!

Anonymous said...

I have found giving immunizations as a Pharmacist to be extremely rewarding- for myself and my patients. Yes, it increases our workload significantly and it would be nice to get some financial benefit from it. But I became a pharmacist to help people, not just for the buck. While I can understand some people's innate resistance to change, I find it disheartening that so many can't see the good in this program. We immunized over 5million people this flu season- so far! That amazes me!
If you are just doing it for the money, realize pharmacy as a profession has to change and progress in order to keep those paychecks we love and adore so much coming. Do you guys really think we are making money off dispensing anymore??? If you do, you're living in a different world than me.
We are expanding into many other clinical services in my district: diabetes management, pain management, travel medicine, oncology, and transplant medicine specialties. I find it inspiring that our company is allowing us to show everyone how much Pharmacists, yes RETAIL Pharmacists, are capable of doing. They did change all pharmacy degrees to DOCTORATES didn't they? And for those who don't have a PharmD, it is still your responsibility to your patients and your profession to continue learning throughout your career. We know (or should know) more than most health care professionals about drug treatment AND disease prevention. Pharmacotherapy, pharmacokinetics, drug-interactions, you name it. I personally enjoy adding to my resume- give me something new to try and I'll show you we, as Pharmacists are more than capable. If you're not, or are just unwilling, maybe you should change professions.

Anonymous said...

I too am an immunizing pharmacist and I love giving the shots, but a lot less than I used to. They are killing me in the fall. WAG isn't the only one arm-twisting their pharmacists into doing shots by witholding bonuses, throwing them into the float pool, etc. So does my company. they used to be grateful that they had several immunizers in their company. Now they disrespect us and treat us like the great unwashed they believe us to be. We used to take appointments for shots to balance out the day and manage the workload. it worked BEAUTIFULLY. Now they overruled that by putting up corporate signs that say "Just fucking walk right on in" . During october I was doing close to 50 vaccinations a day on top of everything I else I was doing being the SOLE PHARMACIST. Some people walked out and called the office when I would tell them the shot time was over an hour. dont like it? well then let me do it like I did before and schedule an appointment. All the paperwork was done in advance and the patient was out in 10 minutes. BUT NOOOO, we dont know shit around the pharmacy. after all, we have only been doing it every day of our miserable careers.
My companys take on my vaccinations last year? 150k in sales. all of which was done by yours truly. My take 0.00

Anonymous said...

I just came across your blog tonight when I googled the key words "Pharmacist", "lose job", and "refuse to give immunizations". Wow - I'm really glad I found your blog. :-) Keep it up! You are frickin' hilarious! But the really sad thing is, you are dead on...

Anonymous said...

Who are we kidding. WAG sucks. They took more support staff away from us and now we not only immunize but have this workload balancing shit also...and heaven forbid you can't read a script and reject it....you are threatened with even less tech hours...It will only get worse and the smart ones will leave. Good riddance. I hope lack of adequate staff support runs this ridiculous company into the ground. "WAG = NO CUSTOMER SERVICE"

Anonymous said...

I was just sort of forced to become an immunizer by duane reade which was just taken over by WAG. I haven't slept well since, imagining all that can go wrong. When I read these comments by pharmacist who have been there, I realized I'm not crazy. Unfortunately I will have to sell my soul for a salary, and do what I don't believe is right. I dream of the day when pharmacist will have some kind of organization that speaks on our behalf. Most of us don't even have a lunch break even though we work 12 hours or more. I don't even think that's crazy anymore. I only realize it when I tell someone else and they are in disbelief. I have digressed, going back to the immunization thing, I have hope that it will not be demanded of us one day.

Anonymous said...

I do not work for WAG but my company is also forcing us to become immunizers. Be an immunizer or be fired, period. I don't know what to do except become one to keep my already stressful, work-overloaded job. If I didn't have all the loans from pharmacy school I would just go do something else. Anything but pharmacy...

Shera said...

Several people are trying to get pharmacists to stand united on the topic that WE SHOULD NOT BE FORCED TO IMMUNIZE! Please lend your support! Now is the time for the drivers to get out of the trunk and back into the driver's seat.
This is new ...
Sign the petition here:

http://www.petitiononline.com/pharm/petition.html

Anonymous said...

My company is forcing us now too. I'm not happy. I have been diabetic for over 25 years and still hate giving myself SQ shots. I asked the coordinator how I'm suddenly going to "get over it" and he said "all my fears will be relieved after training." Don't think so. Personally, I go to the busiest clinic to get my flu shots from a nurse who does it all day, even though I could get it free at work. Philosophically, I'm fine with the profession taking on this patient service, however, I do not feel it should be forced on those of us who do not want to. Nor do I think it will be easy to add the work and stress to the day without adding risk of errors. As a parent, I will only have my children immunized at their pediatrician's office because it is so easy to get a copy of all of their shots with one phone call. How many parents or people will keep records of vaccinations that may need to produce proof later? Not talking about flu shots-- what about Hep B, MMR, tenus, etc? One more thing, we did a shot lab in pharmacy school one night and one unfortunate student ended up standing over the trash can with blood flowing from a poorly placed IM saline shot.

rxchick78 said...

I am horrified at what pharmacy is becoming. I graduated pharmacy school in 2005, and I could've told you where I wanted to go and how much I wanted to make, and it would've happened. Now I feel amazingly lucky to even have a job, with all the "pharmacist factories" out there sending out new, poorly trained pharmacists. I have to work 3 times as hard for less pay...this is not what I signed up for. My independent pharmacy (where I was PIC) was bought out by a chain several months ago, and we are now being forced into immunization. Not that I am against pharmacist immunization in any way, but I am TOTALLY against uncompensated immunization. I already took a massive pay cut for a greatly increased workload. So why not pile a little more work on top of that?? I no longer get a bonus, took a $20,000 cut in salary....seriously?? I need to find a new career. or maybe I should just try to find an independently wealthy husband and be a housewife. If only that were a possibility. sigh.....

Anonymous said...

Why don't you get to the root of the problem. Pharmacy is now a commodity thanks to PBM's and Pharmacy entities that put a price on a prescriptiion that does not even cover the cost to fill the product.

instead of griping about extra work, at this point, maybe you should pray you still have a job in five years.

Pharmacists have the weakest lobbying groups in the medical profession, and you wonder why we have no say in our profession?

Everyone commenting in such a negative manner should take that passion to the legislature and do something about it. Whether you work for a chain or for yourself, if you are in community pharmacy, you will ultimately be doing whatever it takes to keep your job or your business.

We now have a pharmacist surplus in many areas of the country, so the days are gone when the pharmacist gets to dictate what they will or won't do.

Anonymous said...

I'm going to immunization certified because I don't have a regular job and this will increase the number of temp job sites I'm qualified for. I was fired for not letting a jack-ass client yell at me about something that I couldn't do anything about at 10PM. The owner of the company had a restraining order against him at one point for harrasing phone calls. But he is their biggest client.

I'm terrified of stabbing people when I might only do it a couple times a year. But I have to eat. Pharmacy student had it right - they're out there to take your job for less pay because they don't know any better. Makes you not want to be a pharmacist anymore but even $12/hr office jobs in the midwest require 2-3 years experience.

Anonymous said...

Nearly all these comments cover the same issues and I agree with all of them.
What has not been mentioned is efficacy of vaccines! There are all kinds of studies and meta-analyses out there which lead to one conclusion: vaccines given to entire populations are not as efficacious as one might hope or think. It is better to target them to specific, susceptible populations.
I have not even touched upon vaccine damage & those sorts of ramifications. There are many cases of this.